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PubMed2007

Effects of a maximal exercise test on neurocognitive function.

OBJECTIVE: To examine the effects of a maximal exercise test on cognitive function in recreational athletes. DESIGN: A repeated-measures design was used to compare baseline with post-cognitive function and fatigue symptoms after a maximal exercise test. SETTING: Division 1 American Midwestern University, (Michigan State University, Michigan, USA). PARTICIPANTS: 102 male and female recreational athletes. INTERVENTION: Participants in the experimental group (n = 54) were asked to perform a maximal treadmill exercise test to maximal oxygen uptake (VO2 max). Participants in the control group were asked to rest for 15 min. MAIN OUTCOME MEASUREMENTS: All participants were administered a neuropsychological test battery called Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) before and after exercise to measure neurocognitive function and fatigue symptoms. RESULTS: Results revealed a significant group (control, experimental) x time (baseline, post-test 1, post-test 2) interaction for verbal memory composite scores (p = 0.025). Specifically, verbal memory composite scores decreased in the experimental group from baseline to post-test 1 (p = 0.00). These values returned to baseline 3 days after the VO2 max test (p = 0.00). Further analysis on verbal memory composite scores demonstrated significant differences on immediate recall memory (p = 0.00) and delayed recall memory (p = 0.00). No significant differences were observed for visual memory (p = 0.54), motor processing speed (p = 0.68) and reaction time (p = 0.44) composite scores between the experimental and control groups. CONCLUSION: The results of this study suggest that a maximal exercise test attenuated a limiting effect on cognitive function. When utilising a neuropsychological test battery to evaluate a patient who has sustained a head injury, the test should not be administered immediately after a practice or a game session.

Cognition↗
PubMed1995

Ischemia monitoring with on-line vectorcardiography compared with results from a predischarge exercise test in patients with acute ischemic heart disease.

Information from 24-hour monitoring with on-line vectorcardiography, starting immediately after admission, was compared with results from a predischarge exercise test 3-13 days after admission. A total of 169 patients with acute myocardial infarction and 73 patients with unstable angina pectoris were investigated. Patients were followed for 487 +/- 135 days. During the follow-up period, 19 patients (8%) died from cardiac causes and 34 (14%) were hospitalized for a myocardial infarction. The QRS vector difference (QRS-VD), ST change vector magnitude (STC-VM), ST vector magnitude (ST-VM), and ST vector leads X, Y, Z were monitored. Patients with ST depression on the exercise test showed higher occurrence of transient, supposedly ischemic, episodes of QRS-VD, STC-VM, and ST-VM than patients without ST depression. The sensitivity and specificity of identifying patients with ST depression at the exercise test were respectively, 71 and 47% for QRS-VD episodes, 58 and 56% for ST-VM episodes, and 55 and 65% for STC-VM episodes. The maximum ST depression at the exercise test was related to the maximum ST depression in vector lead X (r = .44, P < .001) and the number of STC-VM (r = .40, P < .001), ST-VM (r = .37, P < .001), and QRS-VD (r = .33, P < .001) episodes on the VCG. In multivariate analysis, maximum ST depression in vector lead X and STC-VM episodes were the best determinants for ST depression at the exercise test. In a Cox regression model, the optimal combination of exercise test data in patients who died from cardiac causes exhibited a global chi-square value of 20.0. The combination of these data and the number of STC-VM episodes increased the global chi-square value to 30.6. This study indicates that in patients with acute ischemic heart disease, early continuous vectorcardiographic monitoring may predict the results from a predischarge exercise test and also contributes independent prognostic information beyond that of exercise test data.

Angina, Unstable↗
PubMed1980

Exercise testing after beta-blockade: improved specificity and predictive value in detecting coronary heart disease.

The value of exercise testing in detecting myocardial ischaemia resulting from coronary atheroma remains controversial. In order to increase the reliability of exercise testing, all its components (asymptomatic, haemodynamic, and electrocardiographic) have been scrutinised. In this study, concerned only with the electrocardiographic response to exercise, the incorporation of beta-blockade into the standard exercise procedure has improved specificity and predictive value without affecting sensitivity. Fifty patients with anginal pain and 50 asymptomatic subjects with an abnormal electrocardiogram were investigated by exercise testing before and after beta-blockade (oxprenolol). All subjects had coronary arteriograms and left ventriculograms, and the results of exercise testing were related to the presence or absence of obstructive coronary artery disease. Possible causes of false positive exercise tests were eliminated by echocardiography. Though beta-blockade was unreliable in distinguishing ischaemic from non-ischaemic resting electrocardiograms, it eliminated all the false positive electrocardiographic responses to exercise in both groups and did not abolish any of the true positive electrocardiographic responses. Thus, specificity and predictive value were improved without reduction in sensitivity. This technique may not necessarily be applicable to other groups of patients or to a random population, but the results of this study suggest it will be a useful additional routine procedure in the investigation of coronary heart disease.

Adolescent↗
PubMed2006

Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer.

PURPOSE: The use of cardiopulmonary exercise testing (CPET) is increasing in many areas of disease management, the clinical utility of this procedure in patients with advanced cancer remains to be determined. Accordingly, we conducted a pilot study to comprehensively evaluate the safety and feasibility of CPET in 85 patients diagnosed with inoperable non-small cell lung cancer (NSCLC) or metastatic breast cancer (MBC). METHODS: Using a cross-sectional design, consecutive patients with histologically or cytologically confirmed inoperable NSCLC or MBC were screened for eligibility by their attending oncologist. All consenting patients performed complete pulmonary function tests (NSCLC only) and a symptom-limited CPET on a cycle ergometer with gas exchange analysis. RESULTS: A total of 85 patients (NSCLC, n=46; MBC, n=39) were recruited and tested. Overall, there were a total of three (3.5%) positive exercise tests [NSCLC, n=2 (4.3%); MBC, n=1 (2.6%)]; 68 (80.0%) negative tests [NSCLC, n=33 (71.7%); MBC, n=35 (89.7%)]; and 14 (16.5%) indeterminate tests [NSCLC, n=11 (23.3%); MBC, n=3 (7.7%)]. Two patients experienced an adverse event during exercise testing. Mean VO(2peak) was 17.0mlkg(-1)min(-1) and 16.5mlkg(-1)min(-1) for NSCLC and MBC patients, respectively. The mean percentage of age and sex-predicted VO(2peak) maximum for both groups was 67%. CONCLUSION: A symptom-limited, individualized CPET appears to be a relatively safe and feasible assessment tool to objectively evaluate physical functioning in selected patients with advanced cancer. This study provides important information to future investigations examining the potential role of exercise training in this patient population.

Alberta↗
PubMed1998

Maximal and submaximal exercise testing in heart failure.

Although reduced exercise capacity is the main complaint of patients with congestive heart failure (CHF), the best method to measure it remains controversial. Peak VO2, obtained using maximal exercise testing, is the most accurate measure of maximal functional capacity. It is related to peak exercise cardiac output and is one of the most important independent variables for the prognostic assessment of patients with CHF. It has, however, a low sensitivity for measurement of changes induced by therapy and is poorly related to everyday physical activity, patient symptoms, and quality of life. The anerobic threshold may also be regarded as a parameter of maximal functional capacity. Its value is mainly indirect, because it shows that the patient is performing a maximal effort limited by the cardiovascular system. The VO2 kinetics at the start and at the end of exercise are probably more related to patient symptoms, but it is unresolved which protocols and parameters might best be used to study this aspect of exercise performance. Duration of a submaximal exercise at a constant work rate and the distance walked during a 6-min walking test are gaining wide popularity as parameters of submaximal performance. However, when these exams are carried out up to exhaustion in patients with severe functional limitation, they may involve attainment of the anerobic threshold and therefore their clinical meaning may be similar to the one of a maximal exercise test. Moreover, tests based on the assessment of submaximal exercise capacity have been useful for assessment of therapy in single-center trials but have been often inadequate in multicenter trials.

Anaerobic Threshold↗
PubMed1989

[A map for recording of 15 precordial leads improves the sensitivity of the exercise test].

Authors analyzed ecg recordings of 112 exercise tests performed in males aged 29-62. 15 precordial leads map (inclusive of V1-V6 standard leads) was used to record ecg tracings. In 22 patients (19.5%) ischemic, electrocardiographic changes were only observed at non-standard leads. Obtained data indicate higher sensitivity of the exercise test with ecg recordings enriched by additional leads.

Adult↗
PubMed2006

Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients.

An attenuated heart rate recovery (HRR) immediately after exercise has been shown to be predictive of mortality. It is not known whether HRR predicts mortality when measured in patients with heart failure. The present study was undertaken to evaluate the ability of HRR to predict mortality in patients with heart failure. We studied 84 NYHA class II or III chronic congestive heart failure patients who had a left ventricular ejection fraction < or = 40%. All patients underwent symptom limited cardiopulmonary exercise testing. The value for the HRR was defined as the difference in heart rate between peak exercise and one-minute later; a value < or = 18 beats per minute was considered abnormal. The patients were divided into 2 groups according to the value of HRR. Those with abnormal HRR were assigned to group I and those with normal HRR were assigned to group II. The 2 groups were compared with each other regarding baseline characteristics and exercise capacity assessed by peak VO2. There were 26 patients (31%) in group I and 58 patients (69%) in group II. Group II patients had better performance on treadmill exercise testing than group I patients. They had greater exercise duration (7.5 +/- 3.8 minutes versus 5 +/- 3.5 minutes, P = 0.006), better heart-rate reserve (79 +/- 25% versus 63 +/- 27%, P = 0.01), and higher values of maximal heart-rate (141 +/- 18 beats/min versus 132 +/- 17 beats/min, P = 0.04). Group II patients also had higher peak VO2 values (16.8 +/- 4.4 mL/kg/min versus 14.4 +/- 3.6 mL/kg/min, P = 0.01). When we separated the groups according to beta-blocker usage, beta-blockers had no prominent effect on HRR. In the follow-up period (mean 14.1 +/- 6.1 months), the presence of abnormal HRR and lower peak VO2 (< or = 14 mL/kg/min) were the only significant predictors of mortality in our patient population (adjusted hazard ratio [HR] 5.2, 95% CI, 1.3 to 24, P = 0.03 and adjusted HR 13, 95% CI, 2.1 to 25.6, P = 0.005, respectively). It seems that the attenuated HRR value one minute after peak exercise appears to be a reliable index of the severity of exercise intolerance in heart failure patients and this study supports the value of HRR as a prognostic marker among heart failure patients referred for cardiopulmonary exercise testing for prediction of prognosis.

Aged↗
PubMed1997

Risk stratification in unstable coronary artery disease. Additive value of troponin T determinations and pre-discharge exercise tests. FRISK Study Group.

In 963 patients, participating in a randomized study of low molecular weight heparin in unstable coronary artery disease and followed for 5 months, troponin T was determined. In the 766 patients with a pre-discharge exercise test both troponin T level and exercise test response were independent predictors of prognosis. Cardiac death or myocardial infarction occurred in 5, 9 and 13% of the patients with a maximal troponin T level of < 0.06 (n = 154), 0.06-0.2 (n = 175) and > or = 0.2 microgram.l-1 (n = 437), respectively. Based on exercise tolerance and occurrence of ST depression, patients with a low (n = 361), intermediate (n = 325) and high risk (n = 80) exercise test response were identified. In these, death or myocardial infarction occurred in 5, 13 and 29%, respectively. The combination of troponin T and the exercise test response allowed an even better categorization into low (n = 84), intermediate (n = 406) and high (n = 276) risk groups with 1, 7 and 20% death or myocardial infarction, respectively. Among those 197 patients unable to perform an exercise test the incidence was 3, 16 and 27% in patients with troponin T < 0.06, 0.06-0.2 and > or = 0.2 microgram.l-1, respectively. Thus, troponin T determinations and pre-discharge exercise tests alone and combined are valuable for risk assessment in unstable coronary artery disease.

Aged↗
PubMed1987

Haemodynamics during repeated exercise tests with special reference to the 'warm-up' phenomenon in patients with angina pectoris.

The haemodynamic effect of two successive supine exercise tests 20 min apart was examined in 12 patients with angina pectoris. All the patients had coronary artery disease verified by angiography and were accepted for coronary bypass surgery. They exercised 20-40 W and all of them had angina during the first exercise test. Half the patients did not experience angina during the second of the two exercise tests ('warm-up' responders). In these patients left ventricular filling pressure (LVFP) was reduced by 40% (P less than 0.01) in the second compared to the first exercise test. The non-responders showed no significant change in LVFP. The heart rate pressure product (RPP) and thus myocardial oxygen demand were unchanged in responders and non-responders. In another 10 patients with angina and coronary artery disease, also accepted for coronary bypass surgery, atropine (1.5-2.0 mg) was given intravenously. Ten minutes after administration of atropine, these patients followed exactly the same investigation programme including two successive supine exercise tests as in the group not given atropine. In the group given atropine, four 'warm-up' responders and six non-responders showed the same pattern of response in LVFP as in the group not given atropine. In the 'warm-up' responders a smaller increase in RPP was observed during the second exercise test compared to the first. The present study indicates that cholinergic mechanisms are probably not involved in the 'warm-up' phenomenon. Due to the difference in haemodynamic response, the 'warm-up' phenomenon has to be taken into account when evaluating results from haemodynamic studies of cardiovascular drugs.

Adult↗
PubMed1987

Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease.

To evaluate the significance of ischemic ST-segment depression without associated chest pain during exercise testing, data were analyzed from 2,982 patients from the Coronary Artery Surgery Study (CASS) registry who underwent coronary arteriography and exercise testing and were followed up for 7 years. Patients with proved coronary artery disease (CAD) (at least 70% diameter narrowing) were grouped according to whether they had at least 1 mm of ST-segment depression or anginal chest pain during exercise testing. Four hundred twenty-four had ischemic ST depression without angina (group 1); 232 had angina but no ischemic ST depression (group 2); 456 had both ischemic ST depression and angina (group 3); and 471 had neither ischemic ST depression nor angina (group 4). Sixty-three percent of patients in group 1 and 55% in group 2 had multivessel CAD (difference not significant). The 7-year survival rates were similar for patients in groups 1 (76%), 2 (77%), and 3 (78%), but were significantly better for patients in group 4 (88%, p less than 0.001). Among group 1 patients, survival was related to severity of CAD (p less than 0.001). The 7-year survival rate in group 1 was significantly worse than that in a separate group of 282 patients with ischemic ST depression without angina during exercise testing who had no CAD (95% survival, p less than 0.001). Thus, in patients with silent myocardial ischemia during exercise testing, the extent of CAD and the 7-year survival rate are similar to those of patients with angina during exercise testing. Prognosis is determined primarily by the severity of CAD. In patients without CAD, the survival rate is excellent.

Angina Pectoris↗
PubMed2003

Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room.

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7 12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

Aged↗
PubMed1990

Maximal exercise testing of mentally retarded adolescents and adults: reliability study.

Few data are available regarding maximal exercise testing of mentally retarded individuals. No data are available on the reliability of maximal exercise testing of mentally retarded individuals. The purpose of this study was to determine the reliability of graded exercise testing of mentally retarded adolescents and adults. The testing was conducted at two geographically different centers. At Center A, 14 mentally retarded adolescents (11 boys, three girls) with Down syndrome, who were educable or trainable, were recruited from a nonresidential school. The subjects completed two Balke-Ware treadmill protocols until exhaustion. The treadmill time and heart rate (HR) were recorded. The time between tests was approximately one week. At Center B, 21 mentally retarded adults (14 women, seven men means IQ = 56) were recruited from local workshops and group homes. These subjects completed a treadmill walking protocol, with metabolic measurements, until exhaustion. The time between tests varied from one to four months. At Center A, the subjects achieved a mean treadmill time of 8.72min on test one and 8.84min on test two (means HR = 174 and 175bpm, respectively). The reliability coefficient between the two tests was .94. At Center B, the subjects achieved a mean V0(2)max of 27.2mL.kg-1.min-1 on test one and 26.9mL.kg-1.min-1 on test two. The reliability coefficient was .93. These data show that maximal exercise testing is reliable for these populations of mentally retarded individuals, exhibiting similar values to their nonretarded peers.

Adolescent↗
PubMed1995

Relationship between quality of life and exercise test findings after coronary artery bypass surgery.

We studied the correlation between quality of life and exercise testing in 554 patients 2 years after coronary artery bypass surgery. Quality of life constitutes a person's perceptions of physical and mental functional capacity, health and symptoms. Traditionally, evaluations after coronary bypass surgery have focused on physical performance, medication and anginal symptoms, which cannot be said to represent quality of life. We used the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index for evaluation of quality of life. Significant correlations were found between quality of life and exercise capacity (P < 0.0001), and quality of life and chest pain at exercise for all questionnaires (P < 0.0001). Significant correlations, although of small or moderate magnitude, were found between exercise capacity, chest pain and most subscales of quality of life, with the highest correlation coefficients for dimensions reflecting physical abilities and pain. We conclude that quality of life correlates significantly with exercise capacity and chest pain during exercise 2 years after coronary bypass surgery. However, only dimensions of pain and physical performance are reasonably well correlated with exercise test results. Several aspects of quality of life are only weakly related to exercise test results and may escape identification in an exercise test.

Activities of Daily Living↗
PubMed2001

Cardiopulmonary exercise testing in children: an individualized protocol for workload increase.

OBJECTIVES: To investigate the feasibility of individualized workload increments, as used in adults, for exercise testing in children; and to investigate whether this individualized protocol makes it possible to satisfy the usual criteria for maximal exercise (clinical exhaustion, predicted maximum heart rate [HRmax], oxygen uptake [O(2)] plateau, maximal respiratory exchange ratio > 1.1). DESIGN: Prospective clinical study. SETTING: Pediatric exercise testing laboratory. SUBJECTS: Ninety-two children aged 5 to 17 years with various cardiac and respiratory diseases (33 with asthma, 11 with bronchopulmonary dysplasia, 6 with cystic fibrosis, 10 with congenital heart disease, and 32 miscellaneous). INTERVENTIONS: Individualized maximal incremental exercise testing. The increase in workload was adapted to the individual and was calculated from predicted maximal oxygen uptake (O(2)max) for each child. The test lasted 10 to 12 min. RESULTS: The exercise test was well tolerated by all children and was maximal in all but seven patients. A total of 65.7% of children reached the predicted O(2)max and 68.4% satisfied the criteria for a O(2) plateau at peak exercise. The predicted HRmax was achieved in all but two children. The mean maximal respiratory exchange ratio was 1.06. CONCLUSION: The individualized protocol for increasing workload, based on O(2) rather than power, was well tolerated by children. In our view, the best two criteria for assessing the maximality of the tests were clinical exhaustion and HRmax, especially if the O(2) plateau was not reached. These results suggest that individualized protocols could be used instead of standardized tests for exercise testing in children.

Adolescent↗
PubMedDate not supplied

The place of exercise testing in the investigation of patients with respiratory disorders.

Exercise testing may yield important information in the clinical assessment of patients with a wide variety of conditions. An objective measure of exercise capacity is obtained; limiting factors are identified; the adaptive capacity of the heart and lungs is measured; diagnoses are confirmed or excluded. This paper argues the case for a series of exercise testing procedures which vary from simple ("stages I and II") to complex ("stages III and IV"), which allows exercise testing to be widely applied to clinical investigation and which reserves complex and invasive procedures for the clinical situations in which the information is necessary. Examples are presented to illustrate the relative value of the procedures and the information obtained from each.

Airway Obstruction↗
PubMed1998

Unstable coronary artery disease in post-menopausal women. Identifying patients with significant coronary artery disease by basic clinical parameters and exercise test. IRIS Study Group.

BACKGROUND: The diagnostic information from an ECG taken while at rest and an exercise test is considered less reliable in women than in men, mostly due to a high percentage of false-positive tests. This can be explained by a lower pre-test likelihood of coronary heart disease. AIMS: To evaluate the diagnostic information that can be gained from basic clinical parameters, an ECG and exercise test in a group of post-menopausal women with symptoms of unstable coronary artery disease in order to identify patients with significant coronary artery stenoses. METHODS AND RESULTS: We prospectively studied 200 post-menopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. The diagnostic value of common risk factors, myocardial enzymes and an early exercise test were assessed. A coronary angiogram was performed within 60 days. Median age was 67 years. On admission, 38% had ST depression on an ECG taken while at rest, 76% had T-wave inversion, and 41% increased enzyme levels. The coronary angiogram revealed that 15% had no atherosclerosis, 14% had atherosclerosis but not lesion > or = 50% of luminal diameter and 71% had at least one significant stenosis. Of patients with known indicators of atherosclerotic disease, all but one had atherosclerosis visualized on the coronary angiogram. A relative ST depression > or = 0.1 mV and a low maximum workload at exercise test were strong predictors of significant coronary artery disease. The positive predictive value of ST depression was 91% and of low maximum workload 84% CONCLUSION: In post-menopausal women with signs of unstable angina and ischaemia on an ECG taken while at rest, the prevalence of coronary atherosclerosis is high, 85%. Contrary to earlier studies, ST T-changes at the early exercise test had a high positive predictive value, especially in combination with a low maximum workload with no false-positive results.

Adult↗
PubMed1993

The role of exercise testing in heart failure.

The objectives of exercise testing in congestive heart failure (CHF) may be summarized as follows: (a) detect impaired cardiac performance, (b) grade severity of cardiac failure and classify functional capability, and (c) assess effects of interventions. Several different methods are available to make these assessments, and we have to ask ourselves how well exercise testing achieves these objectives. It has to be kept in mind that the power generated by the exercising muscles is dependent on the oxygen delivery to the skeletal muscles. Oxygen uptake is the result of an integrated performance of the lungs, heart, and peripheral circulation. In patients, as well as in normal subjects, oxygen uptake is related to hemodynamic indices such as cardiac output, stroke volume, or exercise duration when a stepwise regulated maximal exercise protocol is used. However, there are major differences in the concept of a true maximum in normal subjects versus heart failure patients. Fit-normal subjects will achieve a real maximal oxygen uptake, whereas patients may stop testing before a maximum is reached because of symptoms such as dyspnea or leg fatigue. Therefore, it is better if the actual oxygen uptake can be measured. "Peak" rather than true maximal oxygen uptake has been suggested for the classification of the severity of heart failure. Peripheral factors modify the cardiac output through such factors as vascular resistance, organ function, and hormonal release. Maximal exercise will stress the cardiovascular system to a point where the weakest chain will impose a limiting effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗